The (Real) Future of Health Care

Google’s David Feinberg and Dell Med’s Clay Johnston sat down at SXSW to explore what it will take for health care to finally embrace technology.

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Clay Johnston (left) and David Feinberg at South by Southwest

While diverse industries are innovating — often with the help of technology — to improve consumer experiences, increase efficiency and lower costs, health care has hit a wall. Rising costs are not translating to improvements in outcomes. In fact, life expectancy has declined in the U.S. in the last three years.

At South by Southwest in March, two health innovators — David Feinberg, head of Google’s health efforts, and Clay Johnston, dean of the Dell Medical School — sat down to talk about what it will take for health care to finally embrace technology and catch up with society’s interest in health. That conversation, edited and condensed for clarity, follows.

On Our Dysfunctional System

David Feinberg: I would say that our health care system is perfect for what it’s designed to do, and that’s to be provider-centered. We build hospitals because that’s where you go see the doctor, and we build waiting rooms because we want doctors to have inventory. The problem is, we didn’t design the system around patients or communities. It’s broken because we designed it around the wrong people.

Clay Johnston: For me, the really exciting thing is the opportunity to design an academic health system that’s organized around society’s interest in health. And that’s not health care; very few people want more health care. They might need health care, and they’re glad that they have it. But people really want health. The question is: How can we have a disciplined approach to achieving better health outcomes?

DF: I actually think people don’t even just want health. People want to spend time with their grandkids, to not have to worry when their elderly parent has a bunch of appointments. And if you really want people to live long and live well while living long, only 20% of that has to do with doctors and hospitals. You can be born just a few miles apart and have a life expectancy difference of 25 years. When I was born in California, the chance of me getting Type 2 diabetes was 1 in 100. If I was born in that same hospital today, it’s 1 in 3. That’s an example of a food-borne illness that we’ve now created health care systems to try to fix, as opposed to going upstream and trying to fix the problem. Even the rats in New York City have Type 2 diabetes. That’s because our bad food choices are spilling into the sewers.

If we really want to change health care, we have to shift our focus to what matters. We not only have to sequence everyone’s DNA, we have to sequence your ZIP code. We have to understand things like socioeconomic factors, health literacy, cultural issues, loneliness. That’s the stuff that matters. I feel like we keep focusing on making the line go faster at Blockbuster instead of creating Netflix.

I would say that our health care system is perfect for what it’s designed to do, and that’s to be provider-centered. … we designed it around the wrong people.

David Feinberg, M.D.
Google Health Head

On Google’s Efforts to Improve Health

DF: People are coming to Google asking about conditions, medications, symptoms, directions, insurance questions. We really do our best to try to organize the world’s information and make it accessible to everybody. But what if we could take that further? What if we could take that information and customize it so you can then take that in a more meaningful way to your physician? That’s one of the things we’re working on.

On Hiring Talent

DF: Here’s what I’m looking for. I want to be at the kitchen table with the single mom who has two jobs, who has a kid with a bad ear infection, who’s also taking care of her parents and struggling. That’s the person’s voice that I think has been missing and is absolutely crucial. I need those people on my team. Because often, I think a lot of technology companies are solving problems for people that live in Silicon Valley and not people who live in other parts of the country.

CJ: That’s been a voice missing from academia as well. At Dell Med, we’ve been very purposeful about how we get into communities, really learn from those communities, and how we use human-centered design. But then also, how do we enable people from the communities that are most unfairly affected by our current health system to become the innovators and to lead the charge in finding those changes? So, harder work, but I think it’s really important to keep going.

On the Skills Future Physicians Will Need

CJ: Some of it is communication skills. Some of it relates to a different kind of analytical ability. The other thing is that we need physicians who understand the whole health system, including what happens outside the hospital and clinic.